What tests should I request before TRT?

[illinoisguy]

I have my annual physical coming up and am trying to come up with a list of tests I should request. My General Practitioner has always done the tests I've requested and my insurance usually covers the majority of tests. Here our my stats:

46 year old male
6'2"
215 lbs
Decent shape. I have been lifting 3 times a weeks (squats, bench, deadlifts). Finding it harder and harder to make strength gains. Fat around the waist and some around chest (possible slight gynecomastia?)
Energy levels might be a bit lower than normal.
Sometimes have feelings of minor depression
Libido is slightly down

Here is my past test history:

August 2015
Vitamin B12 - 384 pg/mL - Range 193-986 pg/mL

Vitamin D 25-HYDROXY - 24.3 ng/mL Range - 30.0-100.0 ng/mL - Started taking D3 (5,000 IU everyday)

LIPID PANEL
Cholesterol, Total - 171 mg/dL - Range <200 mg/dL
Triglycerides - 91 mg/dL - Range <150 mg/dL
LDL Cholesterol - 80 mg/dL - Range <130 mg/dL
VLDL -18 mg/dL - Range 5-40 mg/dL
Chol/HDL Ratio - 2.34 Range - <4.97
Non HDL Chol -98 mg/dL - Range <130 mg/dL

TSH W REFLEX TO FREE T4 - 1.240 mIU/mL - Range - 0.350-5.500 mIU/mL

CBC, PLATELET
WBC - 5.8 x10(3) uL - Range 4.0-13.0 x10(3) uL
RBC -5.00 x10(6)uL - Range 4.30-5.70 x10(6)uL
HGB -15.5 g/dL - Range 13.0 - 17.0 g/dL
HCT - 44.8 % - Range 37.0-54.0 %
PLT - 359.0 10(3)uL - Range 150.0-450.0 10(3)uL
MCV - 89.6 fL - Range 80.0-99.0 fL
MCH 31.0 pg - Range 27.0 - 33.2 pg
MCHC - 34.6 g/dL - Range 31.0-37.0 g/dL
RDW - 13.8 % - Range 11.5-16.0 %

COMP METABOLIC PANEL (14)
Glucose - 96 mg/dL - Range 70-99 mg/dL
BUN - 10 mg/dL - Range8-20 mg/dL
Creatinine - 0.96 mg/dL - Range 0.70-1.20 mg/dL
GFR - 98 - Range >=60
Calcium, Total - 9.6 mg/dL - Range 8.3-10.3 mg/dL
Alkaline Phosphatase - 63 U/L - Range 45-117 U/L
AST - 26 U/L - Range 15-41 U/L
ALT - 29 U/L - Range 17-63 U/L
Bilirubin, Total -1.8 mg/dL - Range 0.1 - 2.0 mg/dL
Total Protein - 7.5 g/dL - Range 6.1-8.3 g/dL
Albumin - 4.3 g/dL - Range 3.5-4.8 g/dL
Sodium -140 mmol/L - Range 136-144 mmol/L
Potassium - 4.2 mmol/L - Range 3.6-5.1 mmol/L
Chloride -106 mmol/L - Range 101-111 mmol/L
CO2 - 28.0 mmol/L - Range 22.0 - 32.0 mmol/L

Free Testosterone, LC-MS/MS - 119.0 pg/mL - Range 47.0-244.0 pg/mL

Total Testosterone - 781.0 ng/dL - Range 300.0-890.0 ng/dL

Estradiol - 42.1 pg/mL - Range 0.0-39.8 pg/mL - Saw a urologist but nothing really was done.


October 2019
CBC, PLATELET
WBC - 5.9 x10(3) uL - Range 4.0-11.0 x10(3) uL
RBC - 5.20 x10(6)uL - Range 4.30-5.70 x10(6)uL
HGB - 16.0 g/dL - Range 13.0-17.5 g/dL
HCT - 47.3 % - Range 39.0-53.0 %
PLT - 379.0 10(3)uL - Range 150.0 - 450.0 10(3)uL
MCV - 91.0 fL - Range 80.0-100.0 fL
MCH - 30.8 pg - Range 26.0-34.0 pg
MCHC - 33.8 g/dL - Range - 31.0-37.0 g/dL
RDW - 13.5 % - Range 11.0-15.0 %
RDW-SD - 45.8 fL - Range 35.1-46.3 fL

COMP METABOLIC PANEL (14)
Glucose - 97 mg/dL - Range 70-99 mg/dL
Sodium - 136 mmol/L - Range 136-145 mmol/L
Potassium - 4.3 mmol/L - Range 3.5-5.1 mmol/L
Chloride - 105 mmol/L - Range 98-112 mmol/L
CO2 - 25.0 mmol/L - Range 21.0-32.0 mmol/L
Anion Gap - 6 mmol/L - Range 0-18 mmol/L
BUN - 17 mg/dL - Range 7-18 mg/dL
Creatinine - 1.14 mg/dL - Range 0.70-1.30 mg/dL
BUN/CREA Ratio - 14.9 - Range 10.0-20.0
Calcium, Total - 9.9 mg/dL - Range 8.5-10.1 mg/dL
Calculated Osmolality - 283 mOsm/kg - Range 275-295 mOsm/kg
GFR, Non-African American - 78 - Range >=60
GFR, African-American - 90 - Range >=60
AST - 15 U/L - Range 15-37 U/L
ALT - 25 U/L - Range 16-61 U/L
Alkaline Phosphatase - 59 U/L - Range 45-117 U/L
Bilirubin, Total - 1.3 mg/dL - Range 0.1-2.0 mg/dL
Total Protein - 7.6 g/dL - Range 6.4-8.2 g/dL
Albumin - 4.0 g/dL - Range 3.4-5.0 g/dL
Globulin - 3.6 g/dL - Range 2.8-4.4 g/dL
A/G Ratio - 1.1 - Range 1.0-2.0

Ferritin - 19.8 ng/mL - Range 30.0-490.0 ng/mL -Started taking 25mg of iron bisglycinate 3x a week after test

Lipid Panel
Cholesterol, Total - 179 mg/dL - Range <200 mg/dL
HDL Cholesterol - 73 mg/dL - Range 40-59 mg/dL
Triglycerides - 86 mg/dL - Range 30 - 149 mg/dL
LDL Cholesterol - 89 mg/dL - Range <100 mg/dL
VLDL - 17 mg/dL - Range 0-30 mg/dL
Non HDL Chol - 106 mg/dL - Range <130 mg/dL

Iron, Serum - 84 ug/dL - Range 65-175 ug/dL

Free Testosterone, LC-MS/MS - 162.9 pg/mL - Range 47.0-244.0 pg/mL
Total Testosterone - 825.7 ng/dL - Range 300.0-890.0 ng/dL

T3 Free - 2.81 pg/mL - Range 2.40-4.20 pg/mL

Free T4 - 0.9 ng/dL - Range 0.8-1.7 ng/dL
TSH - 1.410 mIU/mL - Range 0.358 - 3.740 mIU/mL

Vitamin D, 25OH, Total - 39.4 ng/mL - Range 30.0-100.0 ng/mL

Estradiol - 41.0 pg/mL - Range 11.0-52.5 pg/mL

DHEA Sulfate, Serum - 110 ug/dL - Range 95 - 530 ug/dL

Prostate Specific Antigen Screen - 0.49 ng/mL - Range <=4.00 ng/mL

LH - 4.4 mIU/mL - Range 1.2-10.6 mIU/mL

FSH - 3.3 mIU/mL - Range 0.7-10.8 mIU/mL

Testosterone, Free, Calc - 140 pg/mL Range 47-244 pg/mL
Percent Free Testosterone - 1.4 % - Range 1.6-2.9 %
Testosterone, Adult, Male - 983 ng/dL - Range 300-890 ng/dL
Testosterone, Bioavailable - 407 ng/dL - Range 131-682 ng/dL
Sex Hormone Binding Globulin - 61 nmol/L - Range 11-80 nmol/L

IGF-1 (Insulin-Like Growth I) - 184 ng/mL - Range 76-230 ng/mL
IGF 1 Z Score Calculation - 1.0

Prolactin - 6.0 ng/mL - Range 2.5-17.4 ng/mL

Cortisol - 15.0 ug/dL - Range 5.27-22.45 µg/dL

Pregnenolone By MS/MS, Serum - 87 ng/dL - Range 23-173 ng/dL

January 2020
Ferritin - 69.1 ng/mL - Range 30.0-490.0 ng/mL
Vitamin D, 25OH, Total - 62.3 ng/mL - Range 30.0-100.0 ng/mL

What tests should I request and my upcoming annual exam? Thoughts/concerns on my past testing history?

Thanks in advance!

 

[Systemlord]

The high SHBG is going to bind up the active T and is why Total T is high relative to the Free T. As for what you can do to decrease the SHBG to free up more active T, not much except for TRT which has a suppressive effect on SHBG in the majority of men.

If you hadn't caught the low ferritin, in the not so distant future MCV, MCHC would have dropped below range and you would have truly experienced hell.

 

[illinoisguy]

Thanks! So I have a couple of follow-up questions:

1. Would a doctor even put me on TRT based on the levels from my last test?
2. Should I ask my general General Practitioner run tests again (insurance covers) or should I go somewhere like discountedlabs.com?
3. When I do get tested again, which specific tests should I be asking for? I feel like I don't need all the tests that I had done in 2019 but maybe I am wrong.

Have a great weekend!

 

[madman]

I have my annual physical coming up and am trying to come up with a list of tests I should request. My General Practitioner has always done the tests I've requested and my insurance usually covers the majority of tests. Here our my stats:

46 year old male
6'2"
215 lbs
Decent shape. I have been lifting 3 times a weeks (squats, bench, deadlifts). Finding it harder and harder to make strength gains. Fat around the waist and some around chest (possible slight gynecomastia?)
Energy levels might be a bit lower than normal.
Sometimes have feelings of minor depression
Libido is slightly down

Here is my past test history:

August 2015
Vitamin B12 - 384 pg/mL - Range 193-986 pg/mL

Vitamin D 25-HYDROXY - 24.3 ng/mL Range - 30.0-100.0 ng/mL - Started taking D3 (5,000 IU everyday)

LIPID PANEL
Cholesterol, Total - 171 mg/dL - Range <200 mg/dL
Triglycerides - 91 mg/dL - Range <150 mg/dL
LDL Cholesterol - 80 mg/dL - Range <130 mg/dL
VLDL -18 mg/dL - Range 5-40 mg/dL
Chol/HDL Ratio - 2.34 Range - <4.97
Non HDL Chol -98 mg/dL - Range <130 mg/dL

TSH W REFLEX TO FREE T4 - 1.240 mIU/mL - Range - 0.350-5.500 mIU/mL

CBC, PLATELET
WBC - 5.8 x10(3) uL - Range 4.0-13.0 x10(3) uL
RBC -5.00 x10(6)uL - Range 4.30-5.70 x10(6)uL
HGB -15.5 g/dL - Range 13.0 - 17.0 g/dL
HCT - 44.8 % - Range 37.0-54.0 %
PLT - 359.0 10(3)uL - Range 150.0-450.0 10(3)uL
MCV - 89.6 fL - Range 80.0-99.0 fL
MCH 31.0 pg - Range 27.0 - 33.2 pg
MCHC - 34.6 g/dL - Range 31.0-37.0 g/dL
RDW - 13.8 % - Range 11.5-16.0 %

COMP METABOLIC PANEL (14)
Glucose - 96 mg/dL - Range 70-99 mg/dL
BUN - 10 mg/dL - Range8-20 mg/dL
Creatinine - 0.96 mg/dL - Range 0.70-1.20 mg/dL
GFR - 98 - Range >=60
Calcium, Total - 9.6 mg/dL - Range 8.3-10.3 mg/dL
Alkaline Phosphatase - 63 U/L - Range 45-117 U/L
AST - 26 U/L - Range 15-41 U/L
ALT - 29 U/L - Range 17-63 U/L
Bilirubin, Total -1.8 mg/dL - Range 0.1 - 2.0 mg/dL
Total Protein - 7.5 g/dL - Range 6.1-8.3 g/dL
Albumin - 4.3 g/dL - Range 3.5-4.8 g/dL
Sodium -140 mmol/L - Range 136-144 mmol/L
Potassium - 4.2 mmol/L - Range 3.6-5.1 mmol/L
Chloride -106 mmol/L - Range 101-111 mmol/L
CO2 - 28.0 mmol/L - Range 22.0 - 32.0 mmol/L

Free Testosterone, LC-MS/MS - 119.0 pg/mL - Range 47.0-244.0 pg/mL

Total Testosterone - 781.0 ng/dL - Range 300.0-890.0 ng/dL

Estradiol - 42.1 pg/mL - Range 0.0-39.8 pg/mL - Saw a urologist but nothing really was done.


October 2019
CBC, PLATELET
WBC - 5.9 x10(3) uL - Range 4.0-11.0 x10(3) uL
RBC - 5.20 x10(6)uL - Range 4.30-5.70 x10(6)uL
HGB - 16.0 g/dL - Range 13.0-17.5 g/dL
HCT - 47.3 % - Range 39.0-53.0 %
PLT - 379.0 10(3)uL - Range 150.0 - 450.0 10(3)uL
MCV - 91.0 fL - Range 80.0-100.0 fL
MCH - 30.8 pg - Range 26.0-34.0 pg
MCHC - 33.8 g/dL - Range - 31.0-37.0 g/dL
RDW - 13.5 % - Range 11.0-15.0 %
RDW-SD - 45.8 fL - Range 35.1-46.3 fL

COMP METABOLIC PANEL (14)
Glucose - 97 mg/dL - Range 70-99 mg/dL
Sodium - 136 mmol/L - Range 136-145 mmol/L
Potassium - 4.3 mmol/L - Range 3.5-5.1 mmol/L
Chloride - 105 mmol/L - Range 98-112 mmol/L
CO2 - 25.0 mmol/L - Range 21.0-32.0 mmol/L
Anion Gap - 6 mmol/L - Range 0-18 mmol/L
BUN - 17 mg/dL - Range 7-18 mg/dL
Creatinine - 1.14 mg/dL - Range 0.70-1.30 mg/dL
BUN/CREA Ratio - 14.9 - Range 10.0-20.0
Calcium, Total - 9.9 mg/dL - Range 8.5-10.1 mg/dL
Calculated Osmolality - 283 mOsm/kg - Range 275-295 mOsm/kg
GFR, Non-African American - 78 - Range >=60
GFR, African-American - 90 - Range >=60
AST - 15 U/L - Range 15-37 U/L
ALT - 25 U/L - Range 16-61 U/L
Alkaline Phosphatase - 59 U/L - Range 45-117 U/L
Bilirubin, Total - 1.3 mg/dL - Range 0.1-2.0 mg/dL
Total Protein - 7.6 g/dL - Range 6.4-8.2 g/dL
Albumin - 4.0 g/dL - Range 3.4-5.0 g/dL
Globulin - 3.6 g/dL - Range 2.8-4.4 g/dL
A/G Ratio - 1.1 - Range 1.0-2.0

Ferritin - 19.8 ng/mL - Range 30.0-490.0 ng/mL -Started taking 25mg of iron bisglycinate 3x a week after test

Lipid Panel
Cholesterol, Total - 179 mg/dL - Range <200 mg/dL
HDL Cholesterol - 73 mg/dL - Range 40-59 mg/dL
Triglycerides - 86 mg/dL - Range 30 - 149 mg/dL
LDL Cholesterol - 89 mg/dL - Range <100 mg/dL
VLDL - 17 mg/dL - Range 0-30 mg/dL
Non HDL Chol - 106 mg/dL - Range <130 mg/dL

Iron, Serum - 84 ug/dL - Range 65-175 ug/dL

Free Testosterone, LC-MS/MS - 162.9 pg/mL - Range 47.0-244.0 pg/mL
Total Testosterone - 825.7 ng/dL - Range 300.0-890.0 ng/dL

T3 Free - 2.81 pg/mL - Range 2.40-4.20 pg/mL

Free T4 - 0.9 ng/dL - Range 0.8-1.7 ng/dL
TSH - 1.410 mIU/mL - Range 0.358 - 3.740 mIU/mL

Vitamin D, 25OH, Total - 39.4 ng/mL - Range 30.0-100.0 ng/mL

Estradiol - 41.0 pg/mL - Range 11.0-52.5 pg/mL

DHEA Sulfate, Serum - 110 ug/dL - Range 95 - 530 ug/dL

Prostate Specific Antigen Screen - 0.49 ng/mL - Range <=4.00 ng/mL

LH - 4.4 mIU/mL - Range 1.2-10.6 mIU/mL

FSH - 3.3 mIU/mL - Range 0.7-10.8 mIU/mL

Testosterone, Free, Calc - 140 pg/mL Range 47-244 pg/mL
Percent Free Testosterone - 1.4 % - Range 1.6-2.9 %
Testosterone, Adult, Male - 983 ng/dL - Range 300-890 ng/dL
Testosterone, Bioavailable - 407 ng/dL - Range 131-682 ng/dL
Sex Hormone Binding Globulin - 61 nmol/L - Range 11-80 nmol/L

IGF-1 (Insulin-Like Growth I) - 184 ng/mL - Range 76-230 ng/mL
IGF 1 Z Score Calculation - 1.0

Prolactin - 6.0 ng/mL - Range 2.5-17.4 ng/mL

Cortisol - 15.0 ug/dL - Range 5.27-22.45 µg/dL

Pregnenolone By MS/MS, Serum - 87 ng/dL - Range 23-173 ng/dL

January 2020
Ferritin - 69.1 ng/mL - Range 30.0-490.0 ng/mL
Vitamin D, 25OH, Total - 62.3 ng/mL - Range 30.0-100.0 ng/mL

What tests should I request and my upcoming annual exam? Thoughts/concerns on my past testing history?

Thanks in advance!

Here is my past test history:

August 2015

Albumin - 4.3 g/dL - Range 3.5-4.8 g/dL

Free Testosterone, LC-MS/MS - 119.0 pg/mL - Range 47.0-244.0 pg/mL

Total Testosterone - 781.0 ng/dL - Range 300.0-890.0 ng/dL

Estradiol - 42.1 pg/mL - Range 0.0-39.8 pg/mL - Saw a urologist but nothing really was done.


No clue where your SHBG sat and as you can see your TT is robust and your FT level is under mid-range.....mind you was tested using the calculated method which I would not rely upon and you would have needed to have your FT tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) to know where your FT level truly sat.

Either way, these labs are outdated!



October 2019

Albumin - 4.0 g/dL - Range 3.4-5.0 g/dL

Free Testosterone, LC-MS/MS - 162.9 pg/mL - Range 47.0-244.0 pg/mL

Total Testosterone - 825.7 ng/dL - Range 300.0-890.0 ng/dL

Estradiol - 41.0 pg/mL - Range 11.0-52.5 pg/mL


Again no clue where your SHBG sat and as you can see TT is robust and your FT is just above mid-range (far from being considered low).....mind you was tested using the calculation method and you would have needed to have it tested using the most accurate assays (ED or UF) to know where your FT level truly sat.



Next set of labs:

Testosterone, Free, Calc - 140 pg/mL Range 47-244 pg/mL
Percent Free Testosterone - 1.4 % - Range 1.6-2.9 %
Testosterone, Adult, Male - 983 ng/dL - Range 300-890 ng/dL
Testosterone, Bioavailable - 407 ng/dL - Range 131-682 ng/dL
Sex Hormone Binding Globulin - 61 nmol/L - Range 11-80 nmol/L


Finally, you had your SHBG tested and it is on the higher end which would definitely have a big impact on binding up your T which would result in a lower FT but it still comes down to where your TT level sits and as you can clearly see your TT is very robust at almost 1000 ng/dL and FT is just below mid-range but far from being considered very low.....mind you was tested using the calculated method which I would not rely upon especially in cases of altered SHBG!

You would need to have your FT tested using the most accurate assays (ED or UF) to know where it truly sits.

Again unfortunately these labs are old and all that truly matters is where your hormones sit as of now 2/2021!




January 2020
Ferritin - 69.1 ng/mL - Range 30.0-490.0 ng/mL
Vitamin D, 25OH, Total - 62.3 ng/mL - Range 30.0-100.0 ng/mL

What tests should I request and my upcoming annual exam? Thoughts/concerns on my past testing history?

Thanks in advance!
----------------------




Nothing to work with here and you would need a full set of labs that includes the most accurate assays for TT/estradiol (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Keep in mind that thyroid/adrenal health is critical and you should get a full thyroid panel /cortisol.

Where does your body fat level sit?

I would look into using Nelsons discounted labs and get this panel which includes the most accurate assays for TT, estradiol, and free testosterone.

Pre Testosterone Replacement Blood Test Panel

Blood Tests Before Starting Testosterone Replacement Therapy TRT

www.discountedlabs.com

Again when it comes to testing FT which is critical you would need to use the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) to know where your FT level truly sits.

Especially in cases of altered SHBG!

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2. Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)

 

[madman]

Again when it comes to testing FT which is critical you would need to use the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) to know where your FT level truly sits.

Especially in cases of altered SHBG!

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2. Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)

 

[illinoisguy]

Thanks! If I go to my regular doctor is there a test number for the gold standard Equilibrium Dialysis or Ultrafiltration tests that I can ask for?

 

[Nelson Vergel]

 

[illinoisguy]

Thanks! I'm assuming this is the same test from ARUP called Testosterone, Bioavailable and Sex Hormone Binding Globulin (Includes Total Testosterone), Adult Male:

So if I asked for the test above along with the following, I should be covered pretty well:

• Ultrasensitive Estradiol - CPT 82670
• CBC, Platelet, No Differential
• Comp, Metabolic Panel (14)
• Vitamin D
• Vitamin B-12
• Ferritin

Anything I'm missing or need to change?

 

[Nelson Vergel]

That is this test

For total T under 1,500 ng/dL

Testosterone, Free, Bioavailable and Total, Immunoassay

TRT Testosterone Panel that includes Testosterone, Free, Bioavailable and Total, Immunoassay , SHBG, albumin

www.discountedlabs.com

For total T over 1,500 ng/dl (also more precise free T)

Testosterone, Free, Bioavailable, and Total, LC/MS/MS (No Upper Limit) plus SHBG

This Testosterone Panel Includes 5 Tests: Total Testosterone (LC/MS most accurate assay), Free Testosterone, Bioavailable Testosterone (Free T plus albumin-bound T), Sex Hormone Binding Globulin (SHBG), and Albumin.

www.discountedlabs.com

For Quest or LabCorp codes just google the name of the test plus the word Quest or LabCorp

 

[illinoisguy]

Is this one called "Testosterone Free and Total by ED/LC-MS/MS (Free) and LC-MS/MS (Total), Adult Males" better:

 

[madman]

Is this one called "Testosterone Free and Total by ED/LC-MS/MS (Free) and LC-MS/MS (Total), Adult Males" better:

View attachment 12871

These are the assays you want when testing TT and FT.

It may be more cost-effective to get them done through discountedlabs.

post #5

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2. Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)


This panel is thorough!

Pre Testosterone Replacement Blood Test Panel

Blood Tests Before Starting Testosterone Replacement Therapy TRT

www.discountedlabs.com

 

[madman]

Is this one called "Testosterone Free and Total by ED/LC-MS/MS (Free) and LC-MS/MS (Total), Adult Males" better:

View attachment 12871

If you are going to use ARUP then these are the assays you want for TT/FT!

 

[illinoisguy]

Thanks! Does it matter what time of day any of the tests I've mentioned are performed? My annual exam is scheduled for the afternoon. Thanks!

 

[Systemlord]

Does it matter what time of day any of the tests I've mentioned are performed? My annual exam is scheduled for the afternoon.

No competent doctor would diagnose low-T with labs taken in the afternoon, testosterone labs are done in the early morning before 10 a.m.

If you were on TRT, lab timing is irrelevant.

 

[madman]

Thanks! Does it matter what time of day any of the tests I've mentioned are performed? My annual exam is scheduled for the afternoon. Thanks!

Natural 24hr circadian rhythm of a healthy young male: levels peak in the early am and decline in the late afternoon/early evening.

Endogenous testosterone secretion is likewise pulsatile and diurnal, with the highest plasma concentrations occurring at about 8 A.M. and the lowest at about 8 P.M.

We want to test at peak so lab work should be done in the early am.

 

[SkyWarn]

I have my annual physical coming up and am trying to come up with a list of tests I should request. My General Practitioner has always done the tests I've requested and my insurance usually covers the majority of tests. Here our my stats:

46 year old male
6'2"
215 lbs
Decent shape. I have been lifting 3 times a weeks (squats, bench, deadlifts). Finding it harder and harder to make strength gains. Fat around the waist and some around chest (possible slight gynecomastia?)
Energy levels might be a bit lower than normal.
Sometimes have feelings of minor depression
Libido is slightly down

Here is my past test history:

August 2015
Vitamin B12 - 384 pg/mL - Range 193-986 pg/mL

Vitamin D 25-HYDROXY - 24.3 ng/mL Range - 30.0-100.0 ng/mL - Started taking D3 (5,000 IU everyday)

LIPID PANEL
Cholesterol, Total - 171 mg/dL - Range <200 mg/dL
Triglycerides - 91 mg/dL - Range <150 mg/dL
LDL Cholesterol - 80 mg/dL - Range <130 mg/dL
VLDL -18 mg/dL - Range 5-40 mg/dL
Chol/HDL Ratio - 2.34 Range - <4.97
Non HDL Chol -98 mg/dL - Range <130 mg/dL

TSH W REFLEX TO FREE T4 - 1.240 mIU/mL - Range - 0.350-5.500 mIU/mL

CBC, PLATELET
WBC - 5.8 x10(3) uL - Range 4.0-13.0 x10(3) uL
RBC -5.00 x10(6)uL - Range 4.30-5.70 x10(6)uL
HGB -15.5 g/dL - Range 13.0 - 17.0 g/dL
HCT - 44.8 % - Range 37.0-54.0 %
PLT - 359.0 10(3)uL - Range 150.0-450.0 10(3)uL
MCV - 89.6 fL - Range 80.0-99.0 fL
MCH 31.0 pg - Range 27.0 - 33.2 pg
MCHC - 34.6 g/dL - Range 31.0-37.0 g/dL
RDW - 13.8 % - Range 11.5-16.0 %

COMP METABOLIC PANEL (14)
Glucose - 96 mg/dL - Range 70-99 mg/dL
BUN - 10 mg/dL - Range8-20 mg/dL
Creatinine - 0.96 mg/dL - Range 0.70-1.20 mg/dL
GFR - 98 - Range >=60
Calcium, Total - 9.6 mg/dL - Range 8.3-10.3 mg/dL
Alkaline Phosphatase - 63 U/L - Range 45-117 U/L
AST - 26 U/L - Range 15-41 U/L
ALT - 29 U/L - Range 17-63 U/L
Bilirubin, Total -1.8 mg/dL - Range 0.1 - 2.0 mg/dL
Total Protein - 7.5 g/dL - Range 6.1-8.3 g/dL
Albumin - 4.3 g/dL - Range 3.5-4.8 g/dL
Sodium -140 mmol/L - Range 136-144 mmol/L
Potassium - 4.2 mmol/L - Range 3.6-5.1 mmol/L
Chloride -106 mmol/L - Range 101-111 mmol/L
CO2 - 28.0 mmol/L - Range 22.0 - 32.0 mmol/L

Free Testosterone, LC-MS/MS - 119.0 pg/mL - Range 47.0-244.0 pg/mL

Total Testosterone - 781.0 ng/dL - Range 300.0-890.0 ng/dL

Estradiol - 42.1 pg/mL - Range 0.0-39.8 pg/mL - Saw a urologist but nothing really was done.


October 2019
CBC, PLATELET
WBC - 5.9 x10(3) uL - Range 4.0-11.0 x10(3) uL
RBC - 5.20 x10(6)uL - Range 4.30-5.70 x10(6)uL
HGB - 16.0 g/dL - Range 13.0-17.5 g/dL
HCT - 47.3 % - Range 39.0-53.0 %
PLT - 379.0 10(3)uL - Range 150.0 - 450.0 10(3)uL
MCV - 91.0 fL - Range 80.0-100.0 fL
MCH - 30.8 pg - Range 26.0-34.0 pg
MCHC - 33.8 g/dL - Range - 31.0-37.0 g/dL
RDW - 13.5 % - Range 11.0-15.0 %
RDW-SD - 45.8 fL - Range 35.1-46.3 fL

COMP METABOLIC PANEL (14)
Glucose - 97 mg/dL - Range 70-99 mg/dL
Sodium - 136 mmol/L - Range 136-145 mmol/L
Potassium - 4.3 mmol/L - Range 3.5-5.1 mmol/L
Chloride - 105 mmol/L - Range 98-112 mmol/L
CO2 - 25.0 mmol/L - Range 21.0-32.0 mmol/L
Anion Gap - 6 mmol/L - Range 0-18 mmol/L
BUN - 17 mg/dL - Range 7-18 mg/dL
Creatinine - 1.14 mg/dL - Range 0.70-1.30 mg/dL
BUN/CREA Ratio - 14.9 - Range 10.0-20.0
Calcium, Total - 9.9 mg/dL - Range 8.5-10.1 mg/dL
Calculated Osmolality - 283 mOsm/kg - Range 275-295 mOsm/kg
GFR, Non-African American - 78 - Range >=60
GFR, African-American - 90 - Range >=60
AST - 15 U/L - Range 15-37 U/L
ALT - 25 U/L - Range 16-61 U/L
Alkaline Phosphatase - 59 U/L - Range 45-117 U/L
Bilirubin, Total - 1.3 mg/dL - Range 0.1-2.0 mg/dL
Total Protein - 7.6 g/dL - Range 6.4-8.2 g/dL
Albumin - 4.0 g/dL - Range 3.4-5.0 g/dL
Globulin - 3.6 g/dL - Range 2.8-4.4 g/dL
A/G Ratio - 1.1 - Range 1.0-2.0

Ferritin - 19.8 ng/mL - Range 30.0-490.0 ng/mL -Started taking 25mg of iron bisglycinate 3x a week after test

Lipid Panel
Cholesterol, Total - 179 mg/dL - Range <200 mg/dL
HDL Cholesterol - 73 mg/dL - Range 40-59 mg/dL
Triglycerides - 86 mg/dL - Range 30 - 149 mg/dL
LDL Cholesterol - 89 mg/dL - Range <100 mg/dL
VLDL - 17 mg/dL - Range 0-30 mg/dL
Non HDL Chol - 106 mg/dL - Range <130 mg/dL

Iron, Serum - 84 ug/dL - Range 65-175 ug/dL

Free Testosterone, LC-MS/MS - 162.9 pg/mL - Range 47.0-244.0 pg/mL
Total Testosterone - 825.7 ng/dL - Range 300.0-890.0 ng/dL

T3 Free - 2.81 pg/mL - Range 2.40-4.20 pg/mL

Free T4 - 0.9 ng/dL - Range 0.8-1.7 ng/dL
TSH - 1.410 mIU/mL - Range 0.358 - 3.740 mIU/mL

Vitamin D, 25OH, Total - 39.4 ng/mL - Range 30.0-100.0 ng/mL

Estradiol - 41.0 pg/mL - Range 11.0-52.5 pg/mL

DHEA Sulfate, Serum - 110 ug/dL - Range 95 - 530 ug/dL

Prostate Specific Antigen Screen - 0.49 ng/mL - Range <=4.00 ng/mL

LH - 4.4 mIU/mL - Range 1.2-10.6 mIU/mL

FSH - 3.3 mIU/mL - Range 0.7-10.8 mIU/mL

Testosterone, Free, Calc - 140 pg/mL Range 47-244 pg/mL
Percent Free Testosterone - 1.4 % - Range 1.6-2.9 %
Testosterone, Adult, Male - 983 ng/dL - Range 300-890 ng/dL
Testosterone, Bioavailable - 407 ng/dL - Range 131-682 ng/dL
Sex Hormone Binding Globulin - 61 nmol/L - Range 11-80 nmol/L

IGF-1 (Insulin-Like Growth I) - 184 ng/mL - Range 76-230 ng/mL
IGF 1 Z Score Calculation - 1.0

Prolactin - 6.0 ng/mL - Range 2.5-17.4 ng/mL

Cortisol - 15.0 ug/dL - Range 5.27-22.45 µg/dL

Pregnenolone By MS/MS, Serum - 87 ng/dL - Range 23-173 ng/dL

January 2020
Ferritin - 69.1 ng/mL - Range 30.0-490.0 ng/mL
Vitamin D, 25OH, Total - 62.3 ng/mL - Range 30.0-100.0 ng/mL

What tests should I request and my upcoming annual exam? Thoughts/concerns on my past testing history?

Thanks in advance!

"Bilirubin, Total -1.8 mg/dL - Range 0.1 - 2.0 mg/dL"
What lab did these tests? I just had a similar test with Quest, my bilirubin was 1.4 and flagged as high. Normal is up to 1.2 with Quest